Provider Demographics
NPI:1932223435
Name:JOSEPH R. VENEMA PH.D. A PSYCHOLOGICAL CORP
Entity Type:Organization
Organization Name:JOSEPH R. VENEMA PH.D. A PSYCHOLOGICAL CORP
Other - Org Name:VENEMA PSYCHOLOGICAL CORP.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:VENEMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-405-0978
Mailing Address - Street 1:595 E COLORADO BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2039
Mailing Address - Country:US
Mailing Address - Phone:626-405-0978
Mailing Address - Fax:626-405-1948
Practice Address - Street 1:595 E COLORADO BLVD
Practice Address - Street 2:SUITE 530
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:626-405-0978
Practice Address - Fax:626-405-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9963103G00000X
CAPSY3770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty